Using a theory-based, customized video game as an educational tool to improve physicians' trauma triage decisions: study protocol for a randomized cluster trial.

Autor: Mohan D; Department of Surgery, University of Pittsburgh School of Medicine, F1265 PUH, 200 Lothrop St, Pittsburgh, PA, 15213, USA. mohand@upmc.edu.; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. mohand@upmc.edu., Angus DC; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Chang CH; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Elmer J; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Fischhoff B; Department of Engineering and Environmental Policy, Carnegie Mellon University, Pittsburgh, PA, USA., Rak KJ; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Barnes JL; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Peitzman AB; Department of Surgery, University of Pittsburgh School of Medicine, F1265 PUH, 200 Lothrop St, Pittsburgh, PA, 15213, USA., White DB; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jazyk: angličtina
Zdroj: Trials [Trials] 2024 Feb 16; Vol. 25 (1), pp. 127. Date of Electronic Publication: 2024 Feb 16.
DOI: 10.1186/s13063-024-07961-w
Abstrakt: Background: Transfer of severely injured patients to trauma centers, either directly from the field or after evaluation at non-trauma centers, reduces preventable morbidity and mortality. Failure to transfer these patients appropriately (i.e., under-triage) remains common, and occurs in part because physicians at non-trauma centers make diagnostic errors when evaluating the severity of patients' injuries. We developed Night Shift, a theory-based adventure video game, to recalibrate physician heuristics (intuitive judgments) in trauma triage and established its efficacy in the laboratory. We plan a type 1 hybrid effectiveness-implementation trial to determine whether the game changes physician triage decisions in real-life and hypothesize that it will reduce the proportion of patients under-triaged.
Methods: We will recruit 800 physicians who work in the emergency departments (EDs) of non-trauma centers in the US and will randomize them to the game (intervention) or to usual education and training (control). We will ask those in the intervention group to play Night Shift for 2 h within 2 weeks of enrollment and again for 20 min at quarterly intervals. Those in the control group will receive only usual education (i.e., nothing supplemental). We will then assess physicians' triage practices for older, severely injured adults in the 1-year following enrollment, using Medicare claims, and will compare under-triage (primary outcome), 30-day mortality and re-admissions, functional independence, and over-triage between the two groups. We will evaluate contextual factors influencing reach, adoption, implementation, and maintenance with interviews of a subset of trial participants (n = 20) and of other key decision makers (e.g., patients, first responders, administrators [n = 100]).
Discussion: The results of the trial will inform future efforts to improve the implementation of clinical practice guidelines in trauma triage and will provide deeper understanding of effective strategies to reduce diagnostic errors during time-sensitive decision making.
Trial Registration: ClinicalTrials.gov; NCT06063434 . Registered 26 September 2023.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje